219495 04/24/2013 CITY OF CARMEL, INDIANA VENDOR: 295900 Page 1 of 1
ONE CIVIC SQUARE ST VINCENT HOSPITAL
CARMEL, INDIANA 46032 EAP CHECK AMOUNT: $1,809.50
8401 HARCOURT ROAD CHECK NUMBER: 219495
INDIANAPOLIS IN 46260
CHECK DATE: 4/24/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 058748374 1, 809 . 50 GENERAL INSURANCE
ST VINCENT EMPL. ASST. PROGRAM
8401 HARCOURT RD
INDIANAPOLIS IN 46260 Date Account Number Balance
04/11/13 5-20376299 1809 . 50
*CITY OF CARMEL.
LAMB, BARB
CITY HALL 1 CIVIC SQUARE
CARMEL, IN 46032
` Please enclose top portion with payment
Rate : 1 . 75 Number of Employees : 526
ACCT # : 5-20376299 PATIENT: *CITY OF CARMEL. CHG AMT PAY/ADJ BALANCE
INVOICE # : 058748374
EMP PROVIDER
04/10/13 CAP MONTHLY CHARGE APRIL 2013 904 . 75
04/10/13 CAP MONTHLY CHARGE MAY 2013 904 . 75
INVOICE BALANCE: 1809 . 50
Account 0-30 days 31-60 days 61-90 days >90 days Balance Due
5-20376299 1809 . 50 0 . 00 0 . 00 0 . 00 ( 1809 . 50
PAGE: 1
ST VINCENT EMPL. ASST. M - F 9a.m. to 4p.m.
8401 HARCOURT RD Ph: 317-338-4900
INDIANAPOLIS IN 46260
Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached inyoice(s)or bill(s))
04/11/13 058748374 $1,809.50
I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
St. Vincent Employee Assistance Program
IN SUM OF $
8401 Harcourt Rd
Indianapolis, IN 46260
$1,809.50
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 I 058748374 I 43-475.00 I $1,809.50 1 hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, April 22, 2013
� r
Director, Adminis ration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund